Provider Demographics
NPI:1922266162
Name:HILES, STACEY LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:LEE
Last Name:HILES
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:17900 TALBOT RD S
Mailing Address - Street 2:STE 101
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-8212
Mailing Address - Country:US
Mailing Address - Phone:425-235-9614
Mailing Address - Fax:425-235-1060
Practice Address - Street 1:17900 TALBOT RD S
Practice Address - Street 2:STE 101
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-8212
Practice Address - Country:US
Practice Address - Phone:425-235-9614
Practice Address - Fax:425-235-1060
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2020-09-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WA60021347207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine